0001193125-08-169421 Sample Contracts

EXHIBIT (4)(a) FORM OF POLICY
Entire Contract • August 7th, 2008 • Separate Account Va Hny • New York

This contract permits the accumulation of funds on a tax-deferred basis and provides a periodic annuity payment for the life of the annuitant or for a certain period of time. Payments start on the annuity commencement date.

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